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General NPI Number Information
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NPI Number | 1841273794
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Entity Type | Individual
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Provider Name | SHIRLEY JEAN CHAMPOUX LMP
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Gender | Female
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4957 LAKEMONT BLVD SE SUITE C3 TAI LAKEMONT PHYSICAL THERAPY
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City | BELLEVUE
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State | WA
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Zip | 98006-7801
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Country | US
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Telephone | 425-401-8406
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Fax | 425-401-8458
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Provider Business Mailing Address
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Address Line | 11481 SW HALL BLVD SUITE 201 THERAPEUTIC ASSOCAITES INC
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City | PORTLAND
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State | OR
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Zip | 97223-8403
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Country | US
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Telephone | 800-219-8835
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Fax | 503-443-1402
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA0004641
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License Number State | WA
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